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PubMed2006

[Natriuretic peptides in heart failure].

The fact that the heart is able to secrete hormones, which are released in significant amounts in advance of certain cardiac conditions, has resulted in a wide range of opportunities and raised a multitude of questions. These hormones, named natriuretic peptides, possess diuretic, natriuretic and vasodilatory properties. The ones used in daily clinical practice are atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and their N-terminal fragments NT-proANP and NT-proBNP, respectively. Although most studies currently involve the use of BNP, the number involving NT-proBNP is expected to increase substantially in coming years because its level is less variable and its half-life longer. Nevertheless, at present there appears to be sufficient evidence to suggest that the plasma levels of these hormones will be extremely useful for the diagnosis, prognosis, screening, pharmacological monitoring, and treatment of patients with heart failure.

Atrial Natriuretic Factor↗

PubMed1984

Cardiac operations in patients with functioning renal allografts.

The Transplant Service at the University of Minnesota Hospitals has performed over 2,000 kidney transplants. Fourteen of these patients have developed cardiac conditions necessitating surgical intervention at intervals of 9 to 144 months (mean 67 months) following their transplantation. These individuals had a mean age of 42 years, and five (36%) were diabetic. All patients had functioning renal allografts with preoperative serum creatinine levels ranging from 1.0 to 1.8 mg/100 ml (mean 1.4 mg/100 ml). Ten patients underwent aorta-coronary saphenous vein bypass grafting. One patient underwent bypass grafting and concomitant left ventricular aneurysmectomy. Native valvular endocarditis developed in two patients. One had tricuspid valve debridement for fungal endocarditis and the other had aortic valve replacement for bacterial endocarditis. The final patient had calcific aortic stenosis and coronary artery disease necessitating aortic valve replacement and coronary bypass. Two patients (14%) died perioperatively. One was a young woman with juvenile-onset diabetes and preinfarction angina who died suddenly several days after the operation; at autopsy, she was found to have an occluded graft to the right coronary artery and extensive infarction. The other was a 54-year-old woman with calcific aortic stenosis, coronary artery disease, and unstable angina who died perioperatively of uncontrollable arrhythmias. Autopsy suggested that she may have had an unsuspected infarction 1 to 2 days before the operation. The remaining 12 patients had uneventful postoperative courses and returned to Class I functional status from a cardiac standpoint. There has been one late death (7%), 45 months after successful coronary artery bypass grafting, as a result of complications attendant to a perforated gastric ulcer. The remaining 11 patients are alive and well at intervals of 8 to 93 months (mean 31 months) after operation. Postoperative serum creatinine levels at hospital discharge averaged 1.6 mg/100 ml, not significantly changed from preoperative levels. Cardiac operations can be performed safely in patients with functioning renal allografts. Patient survival is acceptable and preservation of renal function has been uniformly successful in surviving patients.

Adult↗

PubMed2001

Use of conditionally immortalized mouse cardiac fibroblasts to examine the effect of mechanical stretch on alpha-smooth muscle actin.

Mechanical stretch regulates alpha-smooth muscle actin (SMA) expression in myofibroblasts but limited replication and cellular heterogeneity have hampered definitive studies in vitro. We examined the role of applied force in regulating SMA expression in conditionally immortalized cardiac fibroblast lines derived from H-2Kb-tsA58 transgenic mice. When plated in differentiating conditions (37 degrees C without interferon-gamma), transgenic myofibroblasts exhibited vimentin staining, no desmin staining and abundant SMA in well-developed stress fibers that were indistinguishable from controls. Magnetically-generated tensile forces (approximately 500 pN/cell) applied through collagen-coated magnetite beads selectively reduced SMA but not beta-actin mRNA and protein content in both cell types. The early loss of SMA was due in part to selective leakage into the cell culture medium. Depolymerization of actin filaments with cytochalasin D blocked the force-induced reduction of SMA. Cardiac fibroblast lines established from H-2Kb-tsA58 transgenic mice provide a phenotypically stable source of cells for studying the role of physical forces in regulating SMA.

Actins↗

PubMed1990

Characteristics and natural history of abnormal atrial rhythms in left isomerism.

The object of this study is to document variation in atrial pacemaker rate and P-wave axis, and to clarify the natural history of abnormally slow atrial rhythms in left isomerism. Standard 15-lead electrocardiograms of 50 patients with left isomerism were retrospectively studied. On the average, 9 electrocardiograms covering 7 years for each patient were available. For comparison, atrial rhythms in patients with right isomerism and in those with situs solitus and 5 representative congenital cardiac conditions were studied with the same study protocol. In left isomerism, atrial rhythm with constantly normal P-wave axis was exceptional and the presence of atrial rhythm with abnormal P-wave axis was the rule. The most frequent abnormal mean frontal P-wave axis was between -30 and -90 degrees, recorded in 70%. Slow atrial rates below the second percentile were observed in 50%, either transiently and recurrently (in 40%), or persistently (in 10%), and were associated with junctional escape in 42%. The number of patients with slow atrial rate increased with age. In right isomerism, multiple atrial rhythms were also frequent, but slow atrial rhythms was present in only 4%. Multiple atrial rhythms or bradycardia associated with junctional escape were rare in the group of patients with congenital heart disease and situs solitus. It is concluded that multiplicity and progressive slowing of the atrial rhythm are characteristic in patients with left isomerism.

Abnormalities, Multiple↗

PubMed2004

A novel approach to measure cardiac output noninvasively: a comparison with the thermodilution method on critical care patients.

OBJECTIVE: To compare the accuracy and reliability of cardiac output (CO) measurement by a Noninvasive Hemodynamic Analyzer (NHA) to the thermodilution cardiac output (COTD) technique in ICU patients of cardiac condition. METHOD: ICU retrospective data collected in a 700-bed university-affiliated regional medical center. The data results from 203 patients who required invasive hemodynamic monitoring for clinical and/or surgical management. RESULTS: The ranges of the two CO measurements were: CO(TD) = 2.06 to 8.8 l/min and CO(NHA) = 2.06 to 8.46 l/min, respectively. The Mean and SD of CO(NHA) = 4.819 l/min +/- 1.053 was near to CO(TD) = 4.902 l/min +/- 1.421. Variance was better for CO(NHA) = 1.110 l/min compared to CO(TD) = 1.421 l/min. Median of CO(NHA) showed 4.813 l/min and CO(TD) = 4.660 l/min. Bias was 0.083 l/min with 95% Confidence Interval (Precision): -0.26 to 0.040, and 95% Limits of Agreement was between -1.661 to 1.827 l/min. CONCLUSIONS: The results of this retrospective study indicate that the CO(NHA) technique may be a promising screening method. Additional studies are needed to explore its diagnostic trending capability. This noninvasive CO technique has been proven to be clinically accurate and may be applicable for telemedicine applications.

Algorithms↗

PubMed2000

A non-contact vital signs monitor.

The expansion and contraction of the lungs and heart result in movement of the chest wall that can be detected and monitored to determine respiration and heart rate. A prototype non-contact Vital Signs Monitor (VSM) has been developed which uses very low power, high frequency Doppler radar to detect these motions. Digital signal processing (DSP) techniques, imbedded in the VSM, are used to extract heart and respiration rate information from the resultant waveform. A 10-GHz prototype VSM was developed for the Air Force in the mid-1980s using analog technology. The objective was to assess a fallen soldier's clinical condition at distances up to 100 meters before committing resources to assist that individual. An updated and improved version of the original VSM was developed in 1997. This device was designed to operate at shorter distances, use a higher frequency carrier, and provide more specific heart and respiration rate information using digital signal processing techniques. The VSM radar system is a straightforward homodyne receiver. It operates using frequency modulated continuous wave (FM-CW) transmission, which allows for very low power levels. The safe human power density exposure level at its operating frequency of 35 GHz is 10 mW/cm2. A simple approximation using uniform distribution and an antenna aperture of 2 cm by 3 cm gives a power density at the antenna face of 0.017 mW/cm2, nearly a factor of 1000 below the safe level. When the VSM's antenna is trained on the chest wall of a subject, the VSM is capable of measuring and distinguishing minute movements resulting from the mechanical activity of the heart and lungs. As the subject's chest wall moves, the exact phase of the return signal changes. To avoid the possibility of phase-related dead spots, two signals differing in phase by 90 degrees are used to demodulate the signal to baseband (DC). The two resulting "time-varying DC" signals represent the sine and cosine of a phase angle corresponding to the changing position of the target, in this case the motion of the chest wall. The current VSM operates at a frequency of 35 GHz with a corresponding wavelength of only 8.6 mm. This provides a response sensitive enough to detect the small motions caused by cardiac function. The Vital Signs Monitor has several possible application areas. The fact that it is noncontacting would make it especially attractive for monitoring patients in burn units, NICUs, or trauma centers, where attaching electrodes is either inconvenient or not feasible. Results to date indicate a strong correlation between the cardiac component of the motion signal and an electrocardiogram (ECG). With careful signal processing and analysis, it may be possible to extract clinically useful information about cardiac condition, function, or performance from the surface-motion waveform. This could provide a safe, inexpensive, and painless addition to the diagnostic and monitoring tools currently available to cardiologists. Although there are technical obstacles to overcome in filtering gross motions of the subject, the VSM offers significant advances over conventional methods of measuring heart and respiration rate.

Fetal Monitoring↗

PubMed1988

Abnormal electrical activity induced by free radical generating systems in isolated cardiocytes.

Oxygen free radicals may participate in a variety of pathological cardiac conditions which are associated with an increased incidence of arrhythmias. However, evidence that free radicals per se can alter the electrical function of the myocardium is not convincing. Physiological solutions containing 3 mM dihydroxyfumaric acid (DHF), a compound known to generate free radicals, were superfused over calcium-tolerant cells isolated from the adult canine ventricle. The time course for changes in transmembrane action potentials was monitored using conventional microelectrode techniques. Changes were observed which could be conveniently segregated into three stages. Initially during superfusion with DHF, the voltage of the action potential plateau became more positive and the action potential duration increased (stage 1). Continued superfusion was associated with the development of both early and delayed afterdepolarizations (stage 2), which occasionally produced triggered beats. Subsequently, some cells failed to repolarize beyond -40 mV following an action potential upstroke. In cells which maintained normal levels of resting membrane potential, early and delayed afterdepolarizations ceased concomitant with the development of an increasingly more negative plateau voltage. Action potential duration decreased and plateau potential "collapsed", eventually merging with the resting level of the membrane potential. Resting membrane potential then gradually depolarized to less than -40 mV and all cells became inexcitable within 6 to 20 min (stages 3). Exposure of cells to xanthine (2 mM): xanthine oxidase (0.01 U/ml), another system known to generate free radicals, produced similar results. Superfusion with DHF solutions containing either superoxide dismutase or catalase delayed the appearance and attenuated the development of the changes in the cardiocyte action potential. The results demonstrate that isolated cardiocytes exposed to free radical generating solutions can undergo changes in their electrophysiological activity that resemble those said to underlie disturbances of cardiac rate and rhythm in the clinical setting.

Action Potentials↗

PubMed2005

The neurotoxic effects of prenatal cardiac glycoside exposure: a hypothesis.

Cardiac glycosides (CGs) are beneficial in treating cardiac conditions; depending on time and dosage, they can also be toxic as they regularly cross the blood brain barrier and the placenta and may affect the unborn baby. This paper therefore focuses on the effects of CGs administered to the mother on normal cellular physiology of the foetus with specific reference to neural tissue. CGs act by binding to the Na+/K+-ATPase and decrease or inhibit Na+-K+ pump activity. In the foetus, CGs may disrupt ion homeostasis. An over-dosage of CGs or when it is taken during pregnancy, can also affect the neuro-energy levels of brain tissue in particular. We conclude and hypothesize that CGs in this case will not only cause severe alterations in neuronal function due to disruption of membrane activity, but also in glutamate clearance, affecting neurotransmission in general. Furthermore, elevated cytosolic Ca2+ will lead to permeabilization of the mitochondrial membranes, resulting ultimately in mitochondrial dysfunction. This will result in neurotoxicity--ensuing in neural cell damage or death, and we propose the mechanism to be due to neuro-necrapoptosis.

Animals↗

PubMed2000

Comparison of the acute effects of pacing the atrial septum, right atrial appendage, coronary sinus os, and the latter two sites simultaneously on the duration of atrial activation.

OBJECTIVE: To compare the acute effects of right atrial appendage, atrial septal, coronary sinus os, and dual site pacing on the duration of atrial activation. METHODS: 20 patients with a variety of cardiac conditions underwent an intracardiac electrophysiological study. Electrograms were recorded from the right atrial appendage and at multiple sites within the coronary sinus. The duration of atrial activation was measured during pacing at the right atrial appendage, atrial septum, and coronary sinus os, and also during dual site stimulation. RESULTS: The duration of atrial activation with atrial appendage pacing was notably longer (p < 0.001) than with dual site, septal, or coronary sinus os pacing, but there were no significant differences in atrial activation times between these latter three pacing modes. When stimulating the atria at a cycle length of 500 ms, the mean (SD) duration of atrial activation was 145 (37) ms for right atrial appendage pacing, 93 (26) ms for dual site pacing, 96 (28) ms for septal pacing, and 98 (28) ms for coronary sinus os pacing. CONCLUSIONS: Assuming that the duration of atrial activation is an important determinant of predisposition to paroxysmal atrial fibrillation, atrial septal pacing or coronary sinus os pacing would appear to offer the same advantage as dual site pacing without the additional complexities associated with the latter pacing mode.

Adult↗

PubMed1994

EFFECT OF CORONARY ABLATION AND ADRENERGIC STIMULATION ON IN VIVO CARDIAC PERFORMANCE IN TROUT (ONCORHYNCHUS MYKISS)

In fish, catecholamine-induced changes in cardiac performance in vivo are the result of complex interactions between the direct adrenergic effects on the heart and peripheral circulation and the reflex responses to increased blood pressure. In addition, coronary artery transport of catecholamines and oxygen to the compact myocardium may be essential for maximal in vivo cardiac performance during adrenergic stimulation. Cardiac output (Q(dot)), heart rate (fh), stroke volume (Vs) and dorsal aortic pressure (Pda) were measured in trout with intact or ablated coronary arteries at rest and following intra-arterial administration of 0.2, 0.5, 1.0 and 2.0 µg kg-1 adrenaline. Resting Q(dot), fh, Vs and Pda were the same in fish with intact and ablated coronaries at 48 h post-surgery, averaging approximately 18 ml min-1 kg-1, 42 beats min-1, 0.42 ml kg-1 and 2.2 kPa, respectively. All cardiovascular variables showed a strong relationship between response magnitude and adrenaline dose. However, our results indicate that adrenaline doses above 0.5 µg kg-1 may have a limited ability to increase Q(dot) (ED50 0.22 µg kg-1). Coronary artery ablation had little effect on post-injection Q(dot), Vs, Pda or fh at any dose of adrenaline. In both intact and ablated groups, two types of responses in Q(dot) were observed following adrenaline injection. In the 'type 1' response, Q(dot) increased shortly (1530 s) after adrenaline administration, as increases in Vs more than compensated for a pressor-stimulated reflex bradycardia. In the 'type 2' response, alterations in Q(dot) were biphasic. In the initial minutes post-injection, Q(dot) fell and reached a minimum level at 12 min, the result of an immediate drop in fh and a delayed post-injection increase in Vs. Thereafter, Q(dot) gradually increased as a result of concordant increases in fh and Vs. Although time to maximum Q(dot) was 56 min longer for fish exhibiting type 2 responses, there was no difference in maximum Q(dot) increase or in the time courses for changes in fh and Pda between response types. Our results suggest (1) that during normoxic conditions, cardiac performance does not depend highly on coronary blood flow; (2) that the capacity of adrenaline to increase Q(dot) may be limited by elevations in output pressure and/or by the low dose (concentration) of adrenaline required to achieve near maximal adrenergic stimulation of the heart; and (3) that fish exhibiting type 2 responses have an increased barostatic gain (%delta fh per unit Pda) compared with those with type 1 responses.

Journal Article↗

PubMed2003

Pulmonary venous wedge pressures accurately predict pulmonary arterial pressures in children with single ventricle physiology.

We investigated the relationship between pulmonary venous wedge and pulmonary arterial pressures in patients with single ventricle physiology. This relationship has been studied in other cardiac conditions but not in this unique group of patients. We made 60 paired measurements from one or both lungs in 40 patients, and divided the patients into three groups. Group 1 consisted of patients whose pulmonary blood supply was via an aortopulmonary shunt (n = 14), group 2 included patients with a bi-directional Glenn anastomosis (n = 20), and group 3 included patients with a pulmonary arterial band (n = 6). Venous wedge pressure estimated arterial pressure within 3 mmHg in 59 of 60 paired measurements. Plots of the difference between pulmonary artery and pulmonary venous wedge pressures versus the mean showed excellent correlation, with a mean difference of approximately 1 for group 1 (mean difference, -0.15 +/- 1.3 mmHg) and group 2 (mean difference, 0.52 +/- 1.12 mmHg). The relationship was poor in group 3 (mean difference, -2.00 +/- 4.80 mmHg) but was much better with the exclusion of the one outlying patient in whom pulmonary venous wedge pressure significantly overestimated pulmonary arterial pressure (mean difference, -0.33 +/- 2.07 mmHg). We conclude that pulmonary venous wedge pressure accurately estimates pulmonary arterial pressure in patients palliated for single ventricle physiology, but care must be taken in patients with a pulmonary arterial band.

Arteriovenous Shunt, Surgical↗

PubMed1996

Clinical, electrocardiographic, and echocardiographic features in patients with asymptomatic aortic abdominal aneurysm.

Cardiac involvement in peripheral vascular diseases can present interesting patho-physiological aspects and can influence the prognosis. The authors evaluated the cardiac condition of patients with asymptomatic aortic abdominal aneurysm (AAAA) by using clinical, electrocardiographic, and echocardiographic techniques. Seventy-eight patients were studied, 74 men and 4 women, with ages ranging from fifty-five to eighty-one years (mean 69.5 +/- 6.4). All patients were submitted to a complete clinical examination, usual blood tests, a 12-lead resting electrocardiogram, and an echo-Doppler evaluation. Forty-eight subjects (61.5%) were affected by hypertension, 53 (67.9%) were smokers, 25 (32.1%) were alcohol abusers, 39 (50%) had a history of angina pectoris, 20 (25.6%) had had previous myocardial infarction, and 30 (38.5%) were receiving active cardiovascular treatment. All patients except 2, who had chronic atrial fibrillation, manifested sinus rhythm. Electrocardiographic signs of left ventricular (LV) hypertrophy were present in 20 cases (25.6%), intraventricular conduction disturbances in 19 (24.4%), pathological Q waves in 20 (25.6%), and primary repolarization abnormalities in 25 (32.1%). Echocardiography showed a slight increase in left atrial diameter and intraventricular septum thickness (41.5 +/- 4.3 and 12.3 +/- 2 mm respectively). A clearer increase was found in LV mass index (159 +/- 44 g/m2). In 31 patients one or more LV asynergic segments were found. In our patients with AAAA the prevalence of major risk factors for atherosclerosis and ischemic heart disease including previous myocardial infarction was high. Echo-derived LV myocardial mass index was higher than normal even though electrocardiographic criteria for LV hypertrophy did not match echocardiographic data in all subjects. Finally a moderate prevalence of intraventricular conduction disturbances was recorded.

Aged↗

PubMed2025

Clinical and genetic variant re-analysis among pediatric probands undergoing genetic testing for arrhythmia syndromes.

BACKGROUND: Despite increases in genetic testing, longitudinal data regarding changes in diagnostic yield and variant reclassification for inherited arrhythmia syndromes are limited. OBJECTIVE: Determine longitudinal changes in diagnostic yield and variant classification. METHODS: Single-center retrospective study of probands <18 years undergoing genetic testing for suspected inherited cardiac conditions associated with arrhythmias, 2007 to 2018. Variants were classified as diagnostic (pathogenic/likely pathogenic), non-diagnostic (benign/likely benign [B/LB]), or variants of uncertain significance (VUS). Variant reclassification was performed in October 2023 using VarSome and American College of Medical Genetics criteria. We evaluated results by era (early 2007-2013 vs. later 2014-2018, coinciding with Sanger and next-generation sequencing, respectively) and by likelihood of disease based on clinical evaluation. RESULTS: Of 306 probands, initial testing was 23.2% diagnostic, 55.6% non-diagnostic (33.7% no variant, 21.9% B/LB), and 21.2% VUS. When comparing eras, diagnostic yield decreased (34.1%-15.3%), VUS increased (9.3%-29.9%), and non-diagnostic remained similar (55% to 57%). Variants for 22.7% (46/203) of probands with ≥1 variant changed: 9.9% of diagnostic variants (7/71) downgraded to VUS or non-diagnostic, and 60.0% of VUS changed (23.1% upgraded, 36.9% downgraded). B/LB variants did not change. Probands with higher disease likelihood had 6-times the odds of diagnostic results compared to lower disease likelihood, regardless of era (odds ratio 6.3, 95% confidence interval 3.2-12.4, P < .0001). CONCLUSION: Variant reclassification led to changes in 23% of probands, both downgrading and upgrading status, even among probands initially thought to be pathogenic. When comparing later to earlier eras, VUS variants increased while diagnostic yield decreased. Findings support the need for variant re-interpretation and periodic reclassification over time.

Humans↗

PubMed2006

Comparative study of morphological and time-frequency ECG descriptors for heartbeat classification.

The prompt and adequate detection of abnormal cardiac conditions by computer-assisted long-term monitoring systems depends greatly on the reliability of the implemented ECG automatic analysis technique, which has to discriminate between different types of heartbeats. In this paper, we present a comparative study of the heartbeat classification abilities of two techniques for extraction of characteristic heartbeat features from the ECG: (i) QRS pattern recognition method for computation of a large collection of morphological QRS descriptors; (ii) Matching Pursuits algorithm for calculation of expansion coefficients, which represent the time-frequency correlation of the heartbeats with extracted learning basic waveforms. The Kth nearest neighbour classification rule has been applied for assessment of the performances of the two ECG feature sets with the MIT-BIH arrhythmia database for QRS classification in five heartbeat types (normal beats, left and right bundle branch blocks, premature ventricular contractions and paced beats), as well as with five learning datasets-one general learning set (GLS, containing 424 heartbeats) and four local sets (GLS+about 0.5, 3, 6, 12 min from the beginning of the ECG recording). The achieved accuracies by the two methods are sufficiently high and do not show significant differences. Although the GLS was selected to comprise almost all types of appearing heartbeat waveforms in each file, the guaranteed accuracy (sensitivity between 90.7% and 99%, specificity between 95.5% and 99.9%) was reasonably improved when including patient-specific local learning set (sensitivity between 94.8% and 99.9%, specificity between 98.6% and 99.9%), with optimal size found to be about 3 min. The repeating waveforms, like normal beats, blocks, paced beats are better classified by the Matching Pursuits time-frequency descriptors, while the wide variety of bizarre premature ventricular contractions are better recognized by the morphological descriptors.

Algorithms↗

PubMed2005

Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction.

BACKGROUND: Combinations of aspirin with thienopyridine derivatives (clopidogrel bisulfate or ticlopidine hydrochloride) and/or warfarin sodium are increasingly being used in various cardiac conditions. However, little is known about the bleeding risks associated with these combinations, particularly in elderly individuals at the population level. This study estimates the bleeding risks associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients. METHODS: We conducted a population-based observational cohort study using linked administrative databases. A total of 21,443 elderly survivors of acute myocardial infarction between 1996 and 2000 were studied. Patients were divided into 5 groups according to drug exposure: aspirin alone, warfarin alone, aspirin plus a thienopyridine derivative (antiplatelet combination), aspirin plus warfarin (anticoagulant combination), and aspirin plus warfarin plus a thienopyridine derivative (3-drug combination). Hospitalizations for bleeding events were examined. RESULTS: Hospitalizations for bleeding were observed in 1428 patients (7%). Compared with rates of patients receiving aspirin alone (0.03 per patient-year), rates of bleeding were higher among patients receiving the antiplatelet combination (0.07 per patient-year), the anticoagulant combination (0.08 per patient-year), and the 3-drug combination (0.09 per patient-year). Compared with aspirin alone, the adjusted odds ratios (95% confidence intervals) for bleeding were 1.65 (1.02-2.73) for patients receiving the antiplatelet combination and 1.92 (1.28-2.87) for patients receiving the anticoagulant combination. Only 1 of 141 patients in the 3-drug combination group had a bleeding event. CONCLUSION: In practice, antiplatelet and anticoagulant combinations lead to modest increases in bleeding risk in elderly patients, but the overall risk is small.

Age Factors↗

PubMed1979

Chest wall syndrome. A common cause of unexplained cardiac pain.

Twelve patients with severe, often incapacitating chest pain initially believed to be cardiac in origin were shown on subsequent evaluation to have chest wall syndrome. Diagnosis was suspected by the atypical nature of pain in 11 of 12 patients and confirmed by chest wall tenderness simulating the spontaneously occurring pain in all. Seven patients had chest wall syndrome in conjunction with other associated cardiac conditions. Five patients had isolated chest wall syndrome. All five had normal ejection fractions and no regional wall abnormalities on radionuclide cineangiographic studies performed during symptom-limited supine exercise, findings observed in few patients with coronary artery disease. Chest wall syndrome should be considered in all patients with chest pain, as its recognition can greatly aid in patient care.

Adult↗

PubMed1999

Simulation technology for health care professional skills training and assessment.

Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

Anesthesiology↗

PubMed2000

Simultaneous transcatheter closure of an atrial septal defect with an amplatzer septal occluder and radiofrequency ablation of an accessory connection.

This report describes the first case of simultaneous transcatheter closure of an atrial septal defect and radiofrequency ablation of an accessory connection. This was performed successfully on an 8-year-old boy and represents an attractive therapeutic alternative to surgical repair in this combination of relatively common cardiac conditions.

Catheter Ablation↗